Workplace Incivility in Predicting Turnover Intentions and Job Performance : Study on Nurses of Public Sector Hospitals of Pakistan

Purpose of this study is to investigate the effect of workplace incivility on turnover intention and job performance. Data is collected from 200 nurses of public sector hospitals in Lahore Pakistan through adopted questionnaire. From the data analysis it is found that workplace incivility leads to increase in turnover intention while it negatively affects the job performance of nurses. So it is concluded that misconduct behavior directly harms the workers through increase their turnover intention and decrease the job performance and overall organizational performance.


INTRODUCTION
Mistreatment is a common phenomenon in organizations globally which harms the effectiveness of employees and organizations.Harassment, bulling, incivility and deviance are forms of interpersonal mistreatment.Researchers are extensively investigating these antisocial behaviors which generate emotional deterioration and adversely affect the employees and organizational productivity.Workplace incivility is a form of interpersonal mistreatment which is commonly found in organizations by extensive researchers in their studies.Caza and Cortina (2007) defines; incivility is the behavior that without care violates the norms of organizations.Workplace incivilities have two classifications covert incivility and overt incivility discovered by Cortina et al. (2001).Covert incivility is less noticeable behavior like ignorance and biasness whereas overt incivility recognize easily as rude like verbal abuse (Cortina et al., 2001).This destructive behavior and their effects on employees and overall organizations noticed by many researchers in their studies, for instance Cortina et al. (2013) stated the negative outcome of uncivil behavior on employees at study conducted on US federal court.Moreover, the study on Isfahan Company directed the negative outcome because of Incivility on workplace by Badafshani et al. (2012).Sliter et al. (2012), also shows the nagative outcome of emloyees and organization because of uncivil behavior at workplace.This antisocial behavior creates damaging outcomes of employees and organizational like, low satisfaction, poor job performance, physical and mental sickness and high turnover intention.Turnover intention is define by Robbins and Judge (2013) that somebody is probably assuming to quit the job.Turnover intention is always harmful for organization and employees because it produces cost for organizations.Dion (2006) shows the positive relationship between intention to quit and incivility.Sliter et al. (2012) also stated the impact Incivility on turnover intention and job performance in his study conducted on US banking sector.
Job performance is defined by Motowidlo (2003) as a value of expected by organization from employees over time.Many researchers found the negative relation between incivility and job performance, like Taylor et al. (2012) stated the negative relationship between uncivil behavior and job performance.Porath and Erez (2007) also mentioned the negative relationship between rudeness and job performance.Therefore in view of this disrespectful behavior issues and their negative relation with job performance and positive relation with turnover intension which overall effect the performance of organization, focus of this study will be workplace incivility, turnover intentions and job performance.
Nurses are highly significant in every health care setting around the world.It's a global issue the shortage of nurses in health organizations, specifically in developing countries.In view of Pakistan nurse have less respect which generates stress and adversely impact to perform the duty.This study considers the nurses of Public sector hospitals from Lahore the capital city of Pakistan.Negative behavior is very common towards nurses in public sector hospitals of Pakistan.Because the dominant position between doctors, management, patients and their families and the nature of job like changing clothes of patients, cleaning the body parts and urine.And this the main reason of deviant behavior towards nurses.This area of nurses from public sector hospitals of Pakistan is unaddressed.Therefore this research of negative behavior giving importance to this gap and will try to investigate those problems of nurses which are affecting their outcomes.
Outcomes or workplace incivility largely explored by many researchers in different area of the world, for instance, Cortina et al. (2013) reported that incivility negatively impact on individual behavior and performance in the study of US federal courts.Badafshani et al. (2012) stated incivility influences mainly to turnover intentions.Dion (2006) also noticed workplace incivility and occupational stress increase intention to quit and decreases satisfaction.But this exploration is largely lacking in Pakistan, this study is considering these issues and trying to fill a gap in existing body of knowledge.
Moreover, Sliter et al. (2012) directed that incivility on workplace should be examined multidimensionally, as it can provide well and accurate picture.
(2012), recomendedmultidimensional and cross cultural exploration.Cortina et al. (2013) also shows the need to researcher to give attention towards incivility.Present research values these calls and takings incivility and its two dimensions overt and covert incivility and its impact on turnover intentions and job performance of nurses in public sector hospitals of Pakistan.

LITERATURE REVIEW
Core objective of discussion is to explain the investigation of variables through conceptual and theoretical background.For confirmation of applicability it also includes theoretical relations and empirical support.Moreover discussion includes the concepts of workplace incivility to predict turnover intention and job performance.
Individual mistreatment: Mistreatment is a phenomenon in organizations around the world.And individual mistreatment is perception of employees that they have been treated unfairly on workplace (Olson-Buchanan and Wendy, 2009).Mistreatment includes incivility, harassment, bulling, deviance and injustice.These negative behaviors towards employees harmfully affect their outcomes like turnover intention, job satisfaction and job performance.These antisocial behaviors are widely investigating by researchers in organizations.Workplace incivility is one of the types of individual mistreatment which is persistently noticed by number of researchers in their studies at workplace.

Workplace incivility:
Concepts: Discourteous behavior at workplace towards employees is known as incivility on workplace.
Workplace incivility concept is introduced by Andersson and Pearson (1999) and defined as low intensive deviant behavior towards others which adversely affect organizational norms and employees.According to Caza and Cortina (2007) incivility is the rude and less respective behavior towards others.Uncivil behavior found by many researchers in their studies and coded the damaging effects on outcomes like increase in intent to quit, decrease in job performance, satisfaction and mental disorder.Workplace incivilities negatively affect the performance of employees and adversely influence their behavior and attitude, reported by Cortina et al. (2013) in the study conducted federal courts of US.Similarly a study noticed workplace incivility and the adverse outcome of it like turnover intention and low performance in US banking sector by Sliter et al. (2012).Badafshani et al. (2012) also found the damaging out comes of workplace incivility like turnover intention which related with the cost of employees in the study conducted on Asfahan companies employees.However workplace incivility is very soft form of interpersonal mistreatment but it can become serious and can leeds towards serious nagative outcomes (Porath and Erez, 2007).
The prevalance of workplace incivility stated by many researchers that uncivil behavior can be expensive for organizations, employees or both.Like low job performance, turnover intention and psychological discomfort are stated by Cortina et al. (2013) at faderal court sysytem at US. Lim et al. (2008) mentioned that outcome of employees as a result of uncivil behavior directly effects the organizations and increase the cost related to employees.As an avidance, Laschinger et al. (2014) coded that such a heavy cost of $23.8 billion annually faced by US health sector because of Incivility on workplace.And produtivity cost of per nurse because of uncivil behavior is $11581 annually identified by Lewis and Malecha (2011) at US nurses.Moreover because of incivility at workplace approximately 80% of people reported decrease in productivity and above 10% coded intention to quit the job (Johnson and Indvik, 2004).
Turnover intentions: According to Robbins and Judge (2013), turnover intention is that if someone is thinking to quit the job.From extream to normal intention to quit is fund by many reserchers in their studies (Robbins and Judge, 2007).Sliter et al. (2012) stated that turnover intention is a serious construct which adversily impact the productivity of employees and creat harmful effects for organization.Turnover intentions is the behavior planned by employees according to the situation they faced in organizations by Ajzen (1991) in theory of planned behavior.Many previous studes predicted the intention to quit because of uncivil behavior like Cortina et al. (2013) found the positive relation between incivility and turnover intentions in the study conducted at US faderal court.Badafshani et al. (2012) also found the significant relation between incivility and turnover intentions in the study conducted at Asfahan company employees.
The prevalance of turnover intention, is always significant to appoint and maintain employees who are best for organizations by human resource.Because quality workforce can meet the organizational requirment in this period of globlization which is not easy to find (Lim et al., 2008).As a result of turnover, costing model by Cascio (1991) stated the expences faced by organizations include training cost, sepration and replacment costs.According to Burns (2011) $3500 is the cost of hiring of new employees with $8 wage rate of per hour.Effiliated cost is the significant issue for indvidual and organizations both as an result of turnover.Tziner and Birati (1996) stated a framework that estimates direct and indirect expenses due to weakening in employee self-confidence related with financial costing shape of lower performance.Therefore to retain the workforce a great challenge to maintain the performance of organizations.
Job performance: Job performance of employees is the massive investment considered by employees and its vice versa which is directly impact on organizational effectivness (Motowidlo, 2003).Job performance is defined by Motowidlo (2003) as a value of work by employee which expected by organizations over a period of time.It is assumed that comfort of association as well as on the desirability of association both are affected by job performance.Strees and Mowday (1981) stated relationship between job performance and poor performance which may lead to the bad approach towards the job that ultimately become reason of obstruction and anxiety.Taylor et al. (2012) noticed the negative relationship between negative behavior and performance.Taylor (2010) also found the performance is negatively affected by uncivil behavior.Sliter et al. (2012) in their study on banking sector noticed the performance is affected negatively because of uncivil behavior at workplace.

Relationship between workplace incivility and turnover intentions with theoretical background:
To provide the theoretical foundations for both workplace incivility and turnover intentions and to examine the relationship between them, this study uses the social exchange theory and theory of planned behavior.According to Blau (1964) when anticipated common gains are not taking place between the employees and organization, it escalates the turnover intention.Ajzen (1991) in theory of planned behavior states the behavior of employees changes according to the condition if the condition in their favor they try to stay with organization and it's vice versa.MacKinnon (1994) stated in theory of social exchange, when continues disrespectful behavior occurs, it creates doubt sooner or late.Social exchange theory states that the outcomes adversely effected when individual thinks unfair treatment in organization (Colbert et al., 2004).Badafshani et al. (2012) demonstrated the positive relation in results between workplace incivility and intentions to quit.Finding by Cortina et al. (2001) forecasted turnover intentions take place because of uncivil behavior.Results by Dion (2006) demonstrate the workplace incivility and stress reduce the satisfaction and improve the turnover intention.Hence this study of uncivil behavior impacts on turnover intentions.Thus this study hypothesizes as: H1 : Workplace incivility positively related with turnover intention.H1a : Overt incivility positively related with turnover intention.H1b : Covert incivility positively related with turnover intention.
Relationship between workplace incivility and job performance with theoretical background: According to the social exchange theory unfairness type of act reduce the value of exchange relation.Blau (1964) stated in theory of social exchange, that discourteous behavior adversely impact outcome of employees and organization as an exchange relation (Blau and Andersson, 2005).Effective event theory states that performance is affected through negative mood or event take place because that specifies something is wrong and uncooperative in the environment (Weiss and Cropanzano, 1996).
Many past studies found negative relation between incivility at workplace and job performance, however still work is required through dimensionally and related concepts in different culture and context for more generalizability (Sliter et al., 2012).Porath and Erez (2007) also directed the researchers to examine the same variables at different area to increase its generalizability.Therefore dimensional study of workplace incivility in relation to job performance and their negative effects on nursing area in public hospitals of Pakistan will expand the knowledge.Therefore this study hypothesizes that: H2 : Workplace Incivility adversely related with job performance.H2a : Overt incivility adversely related with job performance.H2b : Covert incivility adversely related with job performance.

Conceptual framework of this study:
The construction of this conceptual framework is based on theoretical support (Fig. 1) and empirical evidences about relationships between workplace incivility,

METHODOLOGY
The present study aims to explore the relationship of workplace incivility with turnover intentions and job performance in nurses of public sector Jinnah hospital of Lahore, Pakistan.A total of 1000 nurses working in Jinnah hospital at different timings.Questionnaire base survey was used to find the respondents and the 10% of whole population is reasonable sample size for this study which is 160 approximately.And effective response rate is found about 86%.
The questionnaire is composed of 20 items for this study, which contains ten items of workplace incivility with its two dimensions of covert and overt incivility.Tarraf (2012) find Alpha (α) is 0.89 for workplace incivility scale of Cortina et al. (2001) that states it extremely reliable.Three items of turnover intentions by Hanisch and Hulin (1991) with Alpha scores (α) is 0.85 for this scale and states it is extremely reliable.And seven items for job performance, last four items of this scale adopted by Motowidlo and Van Scotter (1994) and three items by Kahya (2007) with α scores is 0.95.This Questionnaire used five-point Likert scale.

Estimation of reliability:
The reliability analysis of workplace incivility, turnover intension and job performance have been calculated through SPSS software and result are given in Table 1.Respondent's demographic information on the basis of questionnaire: Demographic information of respondent's being collected from Jinnah Hospital of Pakistan which has been described in the Table 2.The samples of demographics information have been given in Table 2.
Interpretation: Total population of study consist 160 respondents who were the nurses Jinnah Hospital of Lahore.Out of entire population the distribution of population in relation to gender includes male respondent 0 (0%) and female respondent 100 (100%).
Out of total population, (99%) respondents are having bachelor degree and (9%) are having master degree remaining (52%) are belong to others degree in which metric and FA included.And it shows majority of population having Bachelor degree.The above chart 2 describe about the results of the frequency distribution of the designation of the nurses.The designation of the nurses is divided in three categories; lower level, middle level and top level.Out of 160 respondents, there were 86% nurses falling in 1 st category which is lower level.There were 63% nurses whose designation is middle level and 11% nurses lie in the third category which is top level with a percentage The results from the table show that middle level nurses staff dominate the study.About the job experience, Table 2 shows that (91%) respondent were 0-5 years.Then (43%) respondent was on 5-10 years and finally (26%) respondent was on more than 10 years.

Result of descriptive analysis:
Table 3 shows the result of descriptive statistics of sample of 160 respondents.The table shows that workplace incivility has the mean value of 4.1138 which is on higher side.It depicts that nurses have agreed with the researcher's point of view.Workplace incivility also shows the standard deviation 0.21383 with the maximum value at 4.60 and minimum value at 3.70.Turnover intension shows the mean value of 4.2667 which lies in between strongly agrees categories of the questions.The value of dispersion for this variable is 0.32975 with minimum and maximum values at 3.67 and 5.00, respectively.The job performance has the mean value of 1.8589 which depicts that respondents have mostly disagreed.Finally the dispersion value of job performance is 0.31191 with the minimum value of 1.14 and maximum value of 2.57.
Overall the Table 3 describes that nurses have agreed with the assumptions of the researcher.

Correlation analysis:
Result of correlation (r) analysis: Correlation coefficient was calculated with the aim of determining the relation among workplace incivility, turnover intension and job performance in Jinnah Hospital of Pakistan.
The significance value should be below the significance level of 0.01 or 0.05.The significance level shows that is there any significant relationship insist between variables or not?If the value of Pearson correlation is around 0.5 or more, it means that the relationship between two variables is strong and the positive and negative signs show the direction of the relationship.In Table 4 sig (2-tailed) value is 0.000 which shows that there is significant relationship between workplace incivility and turnover intension.The correlation value is 0.822 which depicts that there is strong positive relationship between workplace incivility and turnover intension.So H1 hypothesis has been accepted.
The sig (2-tailed) value for workplace incivility and job performance is 0.424 which is much higher than 0.001.It means that there is no significant relationship between workplace incivility and job performance.The Pearson correlation value for these variables is -0.064 which means that there negative relationship between these two variables.On the basis of these results, H2 hypothesis, which shows that incivility on workplace negatively associated with job performance, has been accepted.

Regression analysis:
Whenever the researchers seek to find the impact of one or more variables on other variables, the regression analysis is used by using the SPSS software.In this research study, regression analysis is used to know the impact of workplace incivility on the turnover intension and job performance.As there are two dependent variables and one independent variable (workplace incivility), so linear regression is used to know the impact of independent variable on the dependent variables.
Workplace incivility with turnover intension: H1: Workplace incivility positively associated with turnover intention.
Interpretation: Table 5 explains the findings of regression analysis of workplace incivility and turnover intension.Turnover intension is taken as dependent variable of this study and workplace incivility is independent variable.The result of regression analysis of workplace incivility and turnover intension shows the value of R $ that is correlation co-efficient to be 0.675 that shows that 67.5% variation in dependent variable is due to independent variable and remaining variation due to other factors.The value of Adjusted R $ is 0.673 that explains the regressed data more accurately because it gives us the value of R $ which is probably more precise and accurate.There should be a very little difference in the values of R $ and Adjusted R $ .But if there is no error (an ideal case), both the values would be similar.It has often seen that if the sample size is not good enough then the value of R $ will be changed which might produce incorrect results.
Beta of workplace incivility and turnover intension is 0.267 that is 26.7% that shows the fact that increase in one unit of independent variable will increase dependent variable by 0.267 and vice versa.P value shows a significance level between both dependent and independent variable.Result shows high level of significance between them (r = 0.267 p<0.01) between workplace incivility and turnover intension and in this way these results supports hypothesis 1 of the study which shows that there exists positive relation between workplace incivility and turnover intension.
Workplace incivility with job performance: H2: Incivility on workplace negatively associated with job performance.
Interpretation: Table 6 explains the findings of regression analysis of workplace incivility and job performance.Workplace incivility is taken as independent variable of this study and job performance is dependent variable.The result of regression analysis of workplace incivility and job performance shows the value of R $ that is correlation co-efficient to be 0.004 that shows that 0.4% variation in dependent variable is due to independent variable and remaining variation due to other factors.
The value of Adjusted R $ is -0.002 that explains the regressed data more accurately because it gives us the value of R $ which is probably more precise and accurate.There should be a very little difference in the values of R $ and Adjusted R $ .But if there is no error (an ideal case), both the values would be similar.It has often seen that if the sample size is not good enough then the value of R $ will be changed which might produce incorrect results.
Beta of workplace incivility and job performance is -0.093 that is that -9.3% shows the fact that increases in one unit of independent variable will increase dependent variable by and vice versa.P value shows a significance level between both dependent and independent variable.Result shows high level of significance between them (r =-0.093 p>0.01) between workplace incivility and job performance and in this way these results supports hypothesis two of the study which shows that there exists negative relation between workplace incivility and job performance.

CONCLUSION
As previously described, the purpose of the study is to find out the effect of workplace incivility on Turnover Intention and Job Performance of the nurses from public sector hospitals.Survey method is opted for this study.Ensuring the anonymity to the respondents about their responses, questions are asked relating to under study variables that are workplace incivility, job performance and turnover intention.Through statistical analysis inferences are drawn regarding the developed hypothesis on the relationship of variables.From the results, it is found that workplace incivility have negative affect on the Job Performance which means workplace incivility reduces the on job performance of employees.These findings confirm the previous results concluded by Sliter et al. (2012).The other understudy relation is between workplace incivility and turnover intention.Through statistical analysis it is found that there is positive relationship between turnover intention and workplace incivility which means workplace incivility increases the intentions of the nurses to quit the job.Numerous previous studies confirm the results of this study (Badafshani et al., 2012;Cortina et al., 2001).
Looking at the results, it can be concluded that Workplace incivility is highly dangerous for the organizations.It not only results in reducing the job performance of employees but also leads them towards the intentions to leave the job.Therefore management of organizations, specifically management of public sector hosptials of the Pakistan should pay attention to factors that are resulting the workplace incivility.And efforts should be made to eliminate such factors in order to provide a safe and secure to nurses for performing their duties.

Fig. 1 :
Fig. 1: Conceptual framework Table 1: Estimates of reliability Variables: Number of items Cronbach's Alpha Workplace incivility: My supervisor or co-worker put me down or arrogant to me in some way.10 0.813 My supervisor or co-worker pay little attention to statements I make or show little interest in my opinion.My supervisor or co-worker makes humiliating, rude or insulting remarks about me.My supervisor or co-worker addresses me in unprofessional terms, either publicly or privately.My supervisor or co-worker Ignores or excludes me from professional companionship.My supervisor or co-worker doubts my judgment in a matter over which I have responsibility.My supervisor or co-worker makes unwanted attempts to draw me into a discussion of personal matters.My supervisor or co-worker ignore me or failed to speak to me.My supervisor or co-worker make jokes at my expense.My supervisor or co-worker Yell or shout at me.Turnover intension: How often do you think about quitting your job? 3 0.751 Leaving my job would be very desirable.It is very likely that I will leave my job.Job performance: I have the knowledge of my job.7 0.844 I can overcome the obstacles to complete my job.I am having problem solving ability.I can operate equipment's using tools or both.I do my work safely.I concentrate on my duties.I try to protect the resources of organization.Overall reliability 20 0.836 turnover intentions and job performance.Framework of this research expresses the relationship of workplace incivility with turnover intentions and job performance of employees.

Table 2 :
Descriptive statistics give details the characteristics of data that includes minimum, maximum, mean and standard deviation.Average scores are calculated with the help of mean that is the measure of central tendency.Mean, median and mode are considering major tools to measure the central tendency.Mean is first choice over others because it provides most accurate results to get the central tendency value.Taking average of score divided by total number to calculate mean.Standard deviation is another statistical tool which is used in this study.It is actually a measure of dispersion of the data.It means that how much the scores are scattered.In this study minimum and maximum values are also used which describe the lowest and highest scores.Descriptive statistics are calculated trough SPSS software.

Table 6 :
Regression analysis of workplace incivility and job performance